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Case Reports
. 2014 Jun 18:79:150-5.
doi: 10.12659/PJR.889690. eCollection 2014.

MRI brain findings in ephedrone encephalopathy associated with manganese abuse: Single-center perspective

Renata Poniatowska  1 , Małgorzata Lusawa  1 , Agnieszka Skierczyńska  1 , Grzegorz Makowicz  1 , Bogusław Habrat  2 , Halina Sienkiewicz-Jarosz  3
Affiliations
Case Reports

MRI brain findings in ephedrone encephalopathy associated with manganese abuse: Single-center perspective

Renata Poniatowska et al. Pol J Radiol. .

Abstract

Background: Manganese (Mn) is a well-known toxic agent causing symptoms of parkinsonism in employees of certain branches of industry. Home production of a psychostimulant ephedrone (methcathinone), involving the use of potassium permanganate, became a new cause of intoxications in Poland.

Case report: This article presents clinical symptoms, initial brain MRI findings and characteristics of changes observed in follow-up examinations in 4 patients with manganese intoxication associated with intravenous administration of ephedrone. All patients in our case series presented symptoms of parkinsonism. T1-WI MRI revealed high intensity signal in globi pallidi in all patients; hyperintense lesions in midbrain were observed in three patients, while lesions located in cerebellar hemispheres and pituitary gland in just one patient. The reduction of signal intensity in the affected brain structures was observed in follow-up studies, with no significant improvement in clinical symptoms.

Conclusions: Brain MRI is helpful in the assessment of distribution as well as dynamics of changes in ephedrone encephalopathy. Regression of signal intensity changes visible in brain MRI is not associated with clinical condition improvement. Although brain MRI findings are not characteristic for ephedrone encephalopathy, they may contribute to diagnosing this condition.

Keywords: Brain Diseases; Manganese Compounds; Metabolic - ultrasonography.

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Figures

Figure 1
Figure 1
Brain MRI T1-WI axial plane of a patient with ephedrone encephalopathy: symmetrical signal increase in globi pallidi.
Figure 2
Figure 2
Brain MRI T1-WI axial plane of a patient with ephedrone encephalopathy at midbrain level: increased signal intensity in cerebral peduncles.
Figure 3
Figure 3
Brain MRI T1-WI sagittal plane of a patient with ephedrone encephalopathy: moderate signal intensity increase in cerebellar hemisphere white matter and significant signal intensity increase in globus pallidus.
Figure 4
Figure 4
Non-enchanced brain MRI T1-WI medial sagittal plane of a patient with ephedrone encephalopathy: significant increase of signal intensity in pituitary gland frontal lobe. In healthy individuals the lobe is isointense with cerebral gray matter.
Figure 5
Figure 5
Brain MRI T2-WI axial plane of a patient with ephedrone encephalopathy: symmetrically low intensity signal in globi pallidi.
Figure 6
Figure 6
Initial brain MRI T1-WI axial plane of a patient with ephedrone encephalopathy: symmetrically high intensity signal in globi pallidi (globus pallidus to frontal lobe white matter signal intensity ratio is ca. 152%).
Figure 7
Figure 7
Follow-up brain MRI T1-WI axial plane of a patient with ephedrone encephalopathy obtained 7 months later: reduction of signal intensity in globi pallidi in comparison to the initial image in Figure 6 (globus pallidus to frontal lobe white matter signal intensity ratio is 105%; signal remains moderately increased compared to healthy individuals).
See this image and copyright information in PMC

References

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